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Publication numberUS20110124964 A1
Publication typeApplication
Application numberUS 13/021,222
Publication dateMay 26, 2011
Filing dateFeb 4, 2011
Priority dateOct 31, 2007
Also published asUS8939897, US20090112059
Publication number021222, 13021222, US 2011/0124964 A1, US 2011/124964 A1, US 20110124964 A1, US 20110124964A1, US 2011124964 A1, US 2011124964A1, US-A1-20110124964, US-A1-2011124964, US2011/0124964A1, US2011/124964A1, US20110124964 A1, US20110124964A1, US2011124964 A1, US2011124964A1
InventorsRudolph H. Nobis
Original AssigneeEthicon Endo-Surgery, Inc.
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Methods for closing a gastrotomy
US 20110124964 A1
Abstract
A surgical instrument for forming a gastrotomy. In various embodiments, the surgical instrument may comprise a hollow tip for attachment to a distal end of a tubular member such as an endoscope. In other embodiments, the hollow tip is integrally formed on the distal end of the endoscope. The hollow tip is configured such that when it is brought into contact with the inner layer of tissue in the stomach, the tissue is caused to stretch. A hole-forming device may be passed through the hollow tip to pierce through the stretched inner layer and adjacent outer layers of tissue to form a passageway therethrough for permitting surgical procedures to be performed therethrough. After the surgical procedures are performed through the passageway, the hollow tip is removed from contact with the inner layer of tissue to permit the inner layer of tissue to relax and to cause the holes formed through the inner layer and outer layers of tissue to be offset from each other.
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Claims(18)
1. A surgical method for forming a gastrotomy through an organ wall having an inner layer of tissue and at least one outer layer of tissue adjacent to said inner layer of tissue, wherein the inner layer of tissue is stretchable from a first relaxed condition to a stretched condition, said method comprising:
stretching the inner layer of tissue to a stretched condition relative to the at least one outer layer of tissue;
forming a first hole through the stretched inner layer of tissue and a second hole through the at least one outer layer of adjacent tissue such that said first and second holes are aligned with each other to permit passage of a surgical instrument therethrough;
performing a surgical procedure through the aligned first and second holes; and
permitting the inner layer to return to the first relaxed condition such that the first and second holes are no longer aligned with each other.
2. The surgical method of claim 1 wherein said stretching comprises:
providing a surgical instrument having a hollow tip thereon, the hollow tip having a tip axis and a distal end that extends at an acute angle relative to the tip axis; and
pushing the angled distal end of the hollow tip into contact with the inner layer of tissue to cause a portion of the inner layer of tissue to move to the stretched condition.
3. The surgical method of claim 2 wherein said forming comprises:
inserting a hole-forming instrument through the surgical instrument and the hollow tip; and
piercing a portion of the hole forming instrument through the portion of stretched inner layer of tissue and the at least one outer layer of tissue adjacent to the portion of stretched inner layer of tissue.
4. The surgical method of claim 2 further comprising applying suction within the hollow tip.
5. The surgical method of claim 2 wherein the surgical instrument comprises an endoscope.
6. The surgical method of claim 5 wherein said pushing comprises:
inserting a portion of the endoscope having the hollow tip thereon through a natural orifice in a patient to bring the hollow tip into engagement with the inner layer of tissue;
an applying a pushing force to another portion of the endoscope protruding out of the natural orifice.
7. The surgical method of claim 2 wherein said permitting comprises removing the angled distal end of the hollow tip from contact with the inner layer of tissue.
8. The surgical method of claim 1 wherein said performing a surgical procedure comprises performing transgastric access.
9. The surgical method of claim 1 wherein said performing a surgical procedure comprises inserting one of a guide wire and a dilating balloon through the aligned first and second holes.
10. The surgical method of claim 2 further comprising
sterilizing the instrument after said removing; and
storing the instrument in a sterile container.
11. A surgical method for forming a gastrotomy through the stomach wall of a patient, said surgical method comprising:
inserting a hollow portion of a surgical instrument through the patient's mouth and esophagus into the patient's stomach such that a hollow tip portion is adjacent a portion of the stomach wall through which the gastrotomy is to be formed;
pressing the hollow tip portion of the surgical instrument into engagement with an inner lining of the stomach wall to stretch the inner lining corresponding to the portion of the stomach wall through which the gastrotomy is to be formed relative to a second layer of stomach wall;
inserting a hole forming device through the hollow portion of the instrument;
forming a first passage through the inner lining and a second passage through the second layer that is axially aligned with the first passage when the inner lining is retained in a stretched condition relative to the second layer of stomach wall;
withdrawing the hole forming device from the instrument;
inserting at least one other surgical instrument through the hollow portion of the instrument and through the aligned first and second passages to perform at least one surgical procedure;
withdrawing all of the at least one other surgical instruments from the hollow portion of the surgical instrument after performing the at least one surgical procedure;
removing the hollow tip portion of the surgical instrument from stretching contact with the inner lining to permit the inner lining to assume an unstretched orientation such that the first passage is no longer aligned with the second passage; and
withdrawing the surgical instrument out of the patient.
12. The surgical method of claim 11 further comprising applying a vacuum within the hollow tip portion to draw the corresponding portion of inner lining into stretched sealing engagement therewith.
13. The surgical method of claim 12 wherein said applying a vacuum comprises applying a suction to the hollow portion of the surgical instrument and maintaining the suction during said forming and performing at least one surgical procedure.
14. The surgical method of claim 11 wherein the hole forming device is selected from the group of surgical instruments comprising a sphinctorotome and a needle knife.
15. The method of claim 11 further comprising inserting a guide wire through the aligned first and second passages prior to withdrawing the hole forming instrument.
16. The method of claim 11 further comprising:
inserting a dilating balloon into the aligned first and second passages after withdrawing the hole forming instrument;
dilating the dilating balloon to expand the aligned first and second passages; and
withdrawing the dilating balloon from the expanded aligned first and second passages prior to inserting the at least one other surgical instrument therethrough.
17. The method of claim 11 wherein the hollow tip portion is removable from the surgical instrument and wherein said method further comprises:
removing the hollow tip portion from the surgical instrument after the surgical instrument has been withdrawn from the patient;
sterilizing the hollow tip portion; and
packaging the sterilized hollow tip portion in a sterile package for reuse.
18. The method of claim 17 further comprising:
sterilizing the surgical instrument; and
packaging the sterilized surgical instrument and the sterilized hollow tip portion in the form of a sterile surgical kit.
Description
    CROSS-REFERENCE TO RELATED APPLICATIONS
  • [0001]
    The present application is a divisional application of and claims the benefit of U.S. patent application Ser. No. 11/981,078, filed Oct. 31, 2007, entitled “Apparatus and Methods For Closing a Gastrotomy” to Rudolph H. Nobis, U.S. Patent Application Publication No. US-2009-0112059-A1, the disclosure of which is hereby incorporated by reference in its entirety.
  • FIELD OF THE INVENTION
  • [0002]
    The present invention relates, in general, to surgical devices and methods of use and, more particularly, to devices and methods relating to closing an opening made through the abdominal wall utilizing laparoscopic surgical instruments and procedures.
  • BACKGROUND OF THE INVENTION
  • [0003]
    Access to the abdominal cavity may, from time to time, be required for diagnostic and therapeutic endeavors for a variety of medical and surgical diseases. Historically, abdominal access has required a formal laparotomy to provide adequate exposure. Such procedures which require incisions to be made in the abdomen are not particularly well-suited for patients that may have extensive abdominal scarring from previous procedures, those persons who are morbidly obese, those individuals with abdominal wall infection, and those patients with diminished abdominal wall integrity, such as patients with burns and skin grafting. Other patients simply do not want to have a scar if it can be avoided.
  • [0004]
    Minimally invasive procedures are desirable because such procedures can reduce pain and provide relatively quick recovery times as compared with conventional open medical procedures. Many minimally invasive procedures are performed with an endoscope (including without limitation laparoscopes). Such procedures permit a physician to position, manipulate, and view medical instruments and accessories inside the patient through a small access opening in the patient's body. Laparoscopy is a term used to describe such an “endosurgical” approach using an endoscope (often a rigid laparoscope). In this type of procedure, accessory devices are often inserted into a patient through trocars placed through the body wall. The trocar must pass through several layers of overlapping tissue/muscle before reaching the abdominal cavity. One of the most significant problems associated with such surgical procedures is the need to provide a secure closure of the gastrotomy site that is required for endoscope passage and, for example, specimen removal. Prior methods required the surgeon to close each of the muscle layers after the procedure is completed.
  • [0005]
    Still less invasive treatments include those that are performed through insertion of an endoscope through a natural body orifice to a treatment region. Examples of this approach include, but are not limited to, cystoscopy, hysteroscopy, esophagogastroduodenoscopy, and colonoscopy. Many of these procedures employ the use of a flexible endoscope during the procedure. Flexible endoscopes often have a flexible, steerable articulating section near the distal end that can be controlled by the user by utilizing controls at the proximal end. Minimally invasive therapeutic procedures to treat diseased tissue by introducing medical instruments to a tissue treatment region through a natural opening of the patient are known as Natural Orifice Translumenal Endoscopic Surgery (NOTES)™. In the past, however, those instruments suited for insertion through a natural orifice lacked means for performing a gastrotomy that avoids the need for the surgeon to separately close each tissue and muscle layer after the operation is completed.
  • [0006]
    Consequently a need exists for devices and methods that can be employed through a patient's natural orifice for closing a gastrotomy while avoiding the need to separately close the hole in each muscle and tissue layer in the abdominal wall.
  • [0007]
    The foregoing discussion is intended only to illustrate some of the shortcomings present in the field of the invention at the time, and should not be taken as a disavowal of claim scope.
  • SUMMARY
  • [0008]
    In one aspect of the invention, there is provided a surgical instrument for forming a gastrotomy. In various embodiments, the instrument comprises a tubular member that has a proximal end and a distal end. A hollow tip is provided on the distal end of the tubular member. The hollow tip has a tip axis and a distal end that extends at an acute angle relative to the tip axis.
  • [0009]
    In another general aspect of various embodiments of the present invention, there is provided a surgical instrument for forming a gastrotomy. In various embodiments, the surgical instrument comprises a hollow tip that is configured for attachment to a distal end of an endoscope. The hollow tip has a tip axis extending therethrough and a distal end that extends at an acute angle relative to the tip axis.
  • [0010]
    In still another general aspect of various embodiments of the present invention, there is provided a surgical method for forming a gastrotomy through an organ wall that has an inner layer of tissue and at least one outer layer of tissue that is adjacent to the inner layer of tissue, wherein the inner layer of tissue is stretchable from a first relaxed condition to a stretched condition. The method may comprise stretching the inner layer of tissue to a stretched condition relative to the at least one outer layer of tissue and forming a first hole through the stretched inner layer of tissue and a second hole through the at least one outer layer of adjacent tissue such that the first and second holes are aligned with each other to permit passage of a surgical instrument therethrough. The method may further comprise performing a surgical procedure through the aligned first and second holes and thereafter permitting the inner layer to return to the first relaxed condition such that said first and second holes are no longer aligned with each other.
  • BRIEF DESCRIPTION OF THE FIGURES
  • [0011]
    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain various principles of the present invention.
  • [0012]
    FIG. 1 is a diagrammatical view illustrating the use of one embodiment of a surgical instrument of the present invention inserted through a patient's mouth and esophagus to perform a gastrotomy through the stomach wall;
  • [0013]
    FIG. 2 is partial perspective view of a portion of an endoscope having a hollow tip of one embodiment of the present invention thereon with the hollow tip shown in cross-section for clarity;
  • [0014]
    FIG. 3 is another view of the endoscope and hollow tip of FIG. 2 in confronting spaced relationship with a portion of the stomach wall;
  • [0015]
    FIG. 4 is another view of the endoscope and hollow tip of FIGS. 2 and 3 in contact with a portion of the inner layer of tissue of the stomach wall;
  • [0016]
    FIG. 5 is another view of the endoscope and hollow tip of FIG. 4 with a hole-forming instrument inserted through a working channel in the endoscope and piercing through the inner and outer layers of tissue;
  • [0017]
    FIG. 6 is another view of the endoscope and hollow tip of FIG. 5 with the hole-forming instrument withdrawn from the inner and outer layers of tissue; and
  • [0018]
    FIG. 7 is a cross-sectional view of a portion of the stomach wall after the endoscope and hollow tip have been removed from contact therewith.
  • DETAILED DESCRIPTION
  • [0019]
    Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
  • [0020]
    It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a clinician manipulating an end of the instrument 20 that protrudes out of the natural orifice. The term “proximal” referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up” and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
  • [0021]
    The present invention generally relates to devices and methods that may be used in connection with endoscopes to perform a gastrotomy through the stomach wall and thereafter have the gastrotomy site be closed without the need for the surgeon to separately close the opening formed in each layer of muscle and tissue. While the various Figures illustrate one form of endoscope with which the various embodiments of the present invention may be advantageously employed, those of ordinary skill in the art will readily appreciate that the unique and novel features of the present invention may be employed with a variety of other forms of endoscopes without departing from the spirit and scope of the present invention.
  • [0022]
    FIG. 1 illustrates, in general form, a surgical instrument 20 of the present invention that can be inserted through a natural orifice to form an opening through the stomach wall 16. In the example depicted in FIG. 1, the instrument 20 is inserted through the mouth 10 and esophagus 12 into the stomach 14 to form an opening through the stomach wall 16. In various embodiments, the instrument 20 may comprise a tubular member sized to receive a surgical instrument. In various embodiments, for example, the tubular member may comprise an endoscope 30 that may be inserted through a substantially hollow overtube 40 that is inserted into the stomach 14 through the patient's mouth 10. A variety of different types of endoscopes are known and, therefore, their specific construction and operation will not be discussed in great detail herein. In various embodiments, the endoscope 30 has a distal end 32 and a proximal end 34 and may operably support a video camera 36 that communicates with a video display unit 40 that can be viewed by the surgeon during the operation. The endoscope 30 may further have one or more working channels 38 extending therethrough for receiving various types of surgical instruments. See FIG. 2.
  • [0023]
    Also in various embodiments of the present invention, a hollow tip 50 may be attached to, or integrally formed on, the distal end 32 of the endoscope 30. In various embodiments, the hollow tip 50 may be attached to the endoscope 30 by, for example, an appropriate adhesive or be pressed onto the distal end 32 and be retained thereon by a “frictional fit”. The hollow tip 50 may be fabricated from, for example, a thermoplastic material and have a tip axis “A-A” that may be substantially coaxially aligned with the central axis of the endoscope 30 when installed thereon. In addition, the hollow tip 50 may be formed with an angled distal end 52 that is angled at an acute angle “a” relative to the tip axis A-A. In various embodiments, the angle a may be, for example, approximately forty-five degrees or from ten degrees to eighty degrees. As will become apparent as the present Detailed Description proceeds, the distal end 52 of the hollow tip is to be formed in such away so that, when pressed against the inner tissue layer 17 of the stomach wall 16, that tissue layer 17 is stretched within the hollow tip 50. In various embodiments, the distal end 52 of the hollow tip 50 may be substantially non-piercing. “Non-piercing” as used herein means that when used as described herein, the tip 50 will not pierce through the organ by itself; however, after the organ is pierced by other means, the hollow tip could be inserted through the opening, if so desired.
  • [0024]
    FIGS. 3-6 illustrate use of the instrument 20. FIG. 3 depicts a portion of the stomach wall 16 through which the gastrotomy will be performed. As can be seen in that Figure, the stomach wall 16 may consist of, for example, a first inner layer of tissue 17 known as mucosa or Rugae that lines the stomach wall 16 and at least a second layer of tissue or muscle 18. The inner layer of tissue 17 is stretchable from a relaxed condition (FIGS. 3 and 7) to a stretched condition (FIGS. 4-6). The second layer 18 of tissue may actually comprise more than one layer or amount of muscle and other tissue. It will be appreciated, however, that all of that tissue/muscle 18 and the inner layer 17 make up the stomach wall 16.
  • [0025]
    As shown in FIG. 3, the surgeon initially manipulates the endoscope 30 to bring the hollow tip 50 into spaced confronting relationship with the portion of the stomach wall 16 through which the gastrotomy is to be performed. Thereafter, the endoscope 30 is manipulated in such a manner to cause the distal end 52 of the hollow tip 50 to be pressed against the inner layer 17 of the stomach wall 16. Because of the differences between the inside layers 17 and outside layers of tissue 18, the tissue layers 17, 18 stretch at different rates. See FIG. 4. In some embodiments, a vacuum instrument 60 may be passed through a working channel 38 in the endoscope 30 to apply a suction or vacuum within the hollow tip 50 from a source of vacuum 62 (FIG. 1) to draw the inner layer 17 of the stomach wall 16 into stretched sealing engagement with the distal end 52 of the hollow tip 50. See FIG. 5.
  • [0026]
    Once the hollow tip 50 is pressed against the inner layer 17 of the stomach wall 16 in the above-described manner, a conventional hole-forming device 70 such as, for example, a conventional Sphinctorotome, a needle knife or other incisor-type instrument is inserted through a working channel 38 to form a continuous hole or passageway 19 through the layers 17 and 18 of the stomach wall 16. See FIG. 5. As can be seen in FIGS. 6 and 7, the continuous hole 19 actually consists of hole segment 19A and hole segment 19B that are aligned with each other. After the hole 19 has been formed through the stomach wall 16, the hole-forming instrument 17 may be withdrawn back through the working channel 38 in the endoscope 30 and other surgical instruments such as, for example, guide wires, dilating balloons, etc. (not shown) may be inserted through the working channels 38 and through the hole 19.
  • [0027]
    After the desired surgical procedures such as, for example, Diagnostic Peritonoscopy or Transgastric Cholecystectomy have been performed through the hole 19, the entire instrument 20 may be removed from the site. After the instrument 20 is removed, the inner tissue layer 17 is once again permitted to move to a relaxed state which causes an offset between the hole segments 19A and 19B as represented by the distance “OS” in FIG. 7. The hole segments 19A and 19B are then permitted to naturally seal through the body's normal healing process.
  • [0028]
    As can be readily appreciated from the foregoing, the various embodiments of the present invention described above represent a vast improvement over prior devices and methods used to form and thereafter close a gastrotomy. The unique and novel features of the present invention enable the operation to be performed through a natural orifice in the patient and thereby avoid several disadvantages associated with other conventional surgical methods and procedures that require incisions to be made into the abdomen. The present invention may encompass tips that are configured for attachment to a distal end of a surgical instrument and, if desired, supplied and/or sold separately from that instrument. Such tips may be pressed onto or otherwise temporarily attached to the distal end of the instrument to complete the above-described procedure and thereafter removed from the instrument and discarded or reprocessed for future use. Other embodiments of the present invention contemplate permanent attachment of the tip to the distal end of the instrument and still other embodiments envision that the angled distal end of the tip be integrally formed on the distal end of the instrument.
  • [0029]
    While several embodiments of the invention have been described, it should be apparent, however, that various modifications, alterations and adaptations to those embodiments may occur to persons skilled in the art with the attainment of some or all of the advantages of the invention. For example, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. This application is therefore intended to cover all such modifications, alterations and adaptations without departing from the scope and spirit of the disclosed invention as defined by the appended claims.
  • [0030]
    The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those of ordinary skill in the art will appreciate that the reconditioning of a device can utilize a variety of different techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
  • [0031]
    Preferably, the invention described herein will be processed before surgery. First a new or used instrument is obtained and, if necessary, cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEKŪ bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or higher energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.
  • [0032]
    Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
  • [0033]
    The invention which is intended to be protected is not to be construed as limited to the particular embodiments disclosed. The embodiments are therefore to be regarded as illustrative rather than restrictive. Variations and changes may be made by others without departing from the spirit of the present invention. Accordingly, it is expressly intended that all such equivalents, variations and changes which fall within the spirit and scope of the present invention as defined in the claims be embraced thereby.
Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US2031682 *Nov 18, 1932Feb 25, 1936Wappler Frederick CharlesMethod and means for electrosurgical severance of adhesions
US3481325 *Mar 31, 1966Dec 2, 1969Jacob A GlassmanGastroscope
US3961632 *Dec 13, 1974Jun 8, 1976Moossun Mohamed HStomach intubation and catheter placement system
US4569347 *May 30, 1984Feb 11, 1986Advanced Cardiovascular Systems, Inc.Catheter introducing device, assembly and method
US4727600 *May 23, 1986Feb 23, 1988Emik AvakianInfrared data communication system
US4815450 *Feb 1, 1988Mar 28, 1989Patel Jayendra IEndoscope having variable flexibility
US4994079 *Jul 28, 1989Feb 19, 1991C. R. Bard, Inc.Grasping forceps
US5098378 *Jul 19, 1991Mar 24, 1992Abbott LaboratoriesMethod of jejunal feeding
US5192300 *Jan 28, 1992Mar 9, 1993Quinton Instrument CompanyInsertion assembly and method of inserting a vessel plug into the body of a patient
US5197963 *Dec 2, 1991Mar 30, 1993Everest Medical CorporationElectrosurgical instrument with extendable sheath for irrigation and aspiration
US5275614 *Jun 12, 1992Jan 4, 1994Habley Medical Technology CorporationAxially extendable endoscopic surgical instrument
US5275616 *Dec 18, 1992Jan 4, 1994Quinton Instrument CompanyInsertion assembly and method of inserting a vessel plug into the body of a patient
US5287852 *Jan 13, 1993Feb 22, 1994Direct Trends International Ltd.Apparatus and method for maintaining a tracheal stoma
US5297687 *Mar 12, 1992Mar 29, 1994Freed Anna BVirtual hinge
US5386817 *Apr 5, 1993Feb 7, 1995Endomedical Technologies, Inc.Endoscope sheath and valve system
US5387259 *Jan 12, 1994Feb 7, 1995Sun Microsystems, Inc.Optical transdermal linking method for transmitting power and a first data stream while receiving a second data stream
US5458583 *Jun 12, 1994Oct 17, 1995Medical Innovations CorporationGastrostomy catheter system
US5591205 *Jun 6, 1995Jan 7, 1997Quinton Instrument CompanyInsertion assembly and method of inserting a vessel plug into the body of a patient
US5601602 *Nov 16, 1994Feb 11, 1997Quinton Instrument CompanyInsertion assembly and method of inserting a vessel plug into the body of a patient
US5607406 *Jan 22, 1995Mar 4, 1997Cordis CorporationRapid exchange segmented catheter
US5609601 *Sep 23, 1994Mar 11, 1997United States Surgical CorporationEndoscopic surgical apparatus with rotation lock
US5704892 *Mar 15, 1996Jan 6, 1998Adair; Edwin L.Endoscope with reusable core and disposable sheath with passageways
US5711921 *Aug 14, 1996Jan 27, 1998Kew Import/Export Inc.Medical cleaning and sterilizing apparatus
US5716375 *Feb 21, 1996Feb 10, 1998Quinton Instrument CompanyInsertion assembly and method of inserting a vessel plug into the body of a patient
US5728094 *May 3, 1996Mar 17, 1998Somnus Medical Technologies, Inc.Method and apparatus for treatment of air way obstructions
US5897487 *Apr 14, 1998Apr 27, 1999Asahi Kogaku Kogyo Kabushiki KaishaFront end hood for endoscope
US6012494 *Mar 18, 1996Jan 11, 2000Deutsche Forschungsanstalt Fur Luft- Und Raumfahrt E.V.Flexible structure
US6016452 *Mar 19, 1997Jan 18, 2000Kasevich; Raymond S.Dynamic heating method and radio frequency thermal treatment
US6017356 *Sep 19, 1997Jan 25, 2000Ethicon Endo-Surgery Inc.Method for using a trocar for penetration and skin incision
US6030384 *May 1, 1998Feb 29, 2000Nezhat; CamranBipolar surgical instruments having focused electrical fields
US6030634 *Dec 15, 1997Feb 29, 2000The Chinese University Of Hong KongPolymer gel composition and uses therefor
US6036640 *Apr 29, 1996Mar 14, 2000Medtronic, Inc.Device and method for repositioning the heart during surgery
US6036685 *Feb 18, 1998Mar 14, 2000Eclipse Surgical Technologies. Inc.Lateral- and posterior-aspect method for laser-assisted transmyocardial revascularization and other surgical applications
US6169269 *Aug 11, 1999Jan 2, 2001Medtronic Inc.Selectively activated shape memory device
US6179832 *Aug 21, 1998Jan 30, 2001Vnus Medical Technologies, Inc.Expandable catheter having two sets of electrodes
US6183420 *Dec 5, 1997Feb 6, 2001Medtronic Ave, Inc.Variable stiffness angioplasty guide wire
US6190383 *Oct 21, 1998Feb 20, 2001Sherwood Services AgRotatable electrode device
US6206904 *Jun 8, 1999Mar 27, 2001Ashai Kogaku Kogyo Kabushiki KaishaForeign body-recovering instrument for endoscope
US6350278 *Oct 18, 1999Feb 26, 2002Medtronic Ave, Inc.Apparatus and methods for placement and repositioning of intraluminal prostheses
US6355013 *Jun 15, 2000Mar 12, 2002Cordis Europe N.V.Balloon catheter with longitudinal safety stop
US6361534 *Apr 14, 2000Mar 26, 2002Ethicon, Inc.Electrosurgical cutting instrument
US6514239 *Mar 19, 2001Feb 4, 2003Olympus Optical Co., Ltd.Medical instrument holding apparatus
US6520954 *Dec 13, 2000Feb 18, 2003Pentax CorporationManipulating section for an endoscopic treatment instrument
US6526320 *May 16, 2001Feb 25, 2003United States Surgical CorporationApparatus for thermal treatment of tissue
US6527782 *Jun 6, 2001Mar 4, 2003Sterotaxis, Inc.Guide for medical devices
US6530922 *Jan 27, 2000Mar 11, 2003Sherwood Services AgCluster ablation electrode system
US6535764 *May 1, 2001Mar 18, 2003Intrapace, Inc.Gastric treatment and diagnosis device and method
US6537200 *Mar 28, 2001Mar 25, 2003Cochlear LimitedPartially or fully implantable hearing system
US6673058 *Jun 20, 2001Jan 6, 2004Scimed Life Systems, Inc.Temporary dilating tip for gastro-intestinal tubes
US6673092 *Aug 24, 2000Jan 6, 2004Karl Storz Gmbh & Co. KgMedical forceps with two independently moveable jaw parts
US6679882 *Nov 17, 2000Jan 20, 2004Lina Medical ApsElectrosurgical device for coagulating and for making incisions, a method of severing blood vessels and a method of coagulating and for making incisions in or severing tissue
US6692493 *Aug 26, 2002Feb 17, 2004Cosman Company, Inc.Method for performing intraurethral radio-frequency urethral enlargement
US6706018 *Dec 4, 2001Mar 16, 2004Cardiac Pacemakers, Inc.Adjustable length catheter assembly
US6709188 *Apr 2, 2002Mar 23, 2004Alps Electric Co., Ltd.Fitting structure for knobs
US6709445 *Feb 21, 2001Mar 23, 2004Richard Wolf GmbhForceps for dissecting free tissue in body cavities
US6840246 *Jun 15, 2001Jan 11, 2005University Of Maryland, BaltimoreApparatuses and methods for performing minimally invasive diagnostic and surgical procedures inside of a beating heart
US6840938 *Dec 21, 2001Jan 11, 2005Intuitive Surgical, Inc.Bipolar cauterizing instrument
US6918906 *Mar 25, 2002Jul 19, 2005Gary L. LongEndoscopic ablation system with improved electrode geometry
US6989028 *Jan 30, 2002Jan 24, 2006Edwards Lifesciences AgMedical system and method for remodeling an extravascular tissue structure
US6991631 *Feb 13, 2003Jan 31, 2006Arthrocare CorporationElectrosurgical probe having circular electrode array for ablating joint tissue and systems related thereto
US7001341 *Aug 13, 2003Feb 21, 2006Scimed Life Systems, Inc.Marking biopsy sites
US7160296 *May 10, 2002Jan 9, 2007Rita Medical Systems, Inc.Tissue ablation apparatus and method
US7323006 *Mar 30, 2004Jan 29, 2008Xtent, Inc.Rapid exchange interventional devices and methods
US7329256 *Dec 23, 2005Feb 12, 2008Sherwood Services AgVessel sealing instrument
US7335220 *Nov 5, 2004Feb 26, 2008Access Closure, Inc.Apparatus and methods for sealing a vascular puncture
US7476237 *Feb 23, 2004Jan 13, 2009Olympus CorporationSurgical instrument
US7485093 *Mar 25, 2004Feb 3, 2009Given Imaging Ltd.Device and method for in-vivo sensing
US7494499 *Feb 14, 2003Feb 24, 2009Olympus CorporationSurgical therapeutic instrument
US7648519 *Jan 2, 2007Jan 19, 2010Cambridge Endoscopic Devices, Inc.Surgical instrument
US7650742 *Oct 19, 2004Jan 26, 2010Tokyo Rope Manufacturing Co., Ltd.Cable made of high strength fiber composite material
US7666203 *May 7, 2004Feb 23, 2010Nmt Medical, Inc.Transseptal puncture apparatus
US7867216 *Jan 19, 2006Jan 11, 2011St. Jude Medical, Cardiology Division, Inc.Emboli protection device and related methods of use
US7879004 *Dec 13, 2006Feb 1, 2011University Of WashingtonCatheter tip displacement mechanism
US7892220 *Oct 4, 2006Feb 22, 2011Ethicon Endo-Surgery, Inc.Use of an adhesive as an intestinal barrier for bariatrics
US8088062 *Jun 28, 2007Jan 3, 2012Ethicon Endo-Surgery, Inc.Interchangeable endoscopic end effectors
US8096459 *Oct 11, 2005Jan 17, 2012Ethicon Endo-Surgery, Inc.Surgical stapler with an end effector support
US8118821 *Oct 8, 2008Feb 21, 2012Cook Medical Technologies LlcMagnetic anastomosis device having improved delivery
US20020022771 *Oct 15, 2001Feb 21, 2002Ananias DioknoDisconnectable vaginal speculum with removeable blades
US20020029055 *Jun 1, 2001Mar 7, 2002Bonutti Peter M.Apparatus and method for tissue removal
US20030014090 *Jan 23, 2001Jan 16, 2003Hans AbrahamsonWireless communication system for implamtable medical devices
US20030023255 *Jun 28, 2002Jan 30, 2003Miles Scott D.Cannulation apparatus and method
US20040002683 *Dec 12, 2002Jan 1, 2004Nicholson Thomas J.Percutaneous medical insertion device
US20040024414 *Jul 1, 2003Feb 5, 2004Downing Stephen W.Apparatuses and methods for performing minimally invasive diagnostic and surgical procedures inside of a beating heart
US20040034369 *May 15, 2003Feb 19, 2004Sauer Jude S.System for endoscopic suturing
US20040054322 *Sep 12, 2003Mar 18, 2004Vargas Jaime SalvadorShape-transferring cannula system and method of use
US20050004515 *Apr 26, 2004Jan 6, 2005Hart Charles C.Steerable kink resistant sheath
US20050033265 *Jul 14, 2004Feb 10, 2005Medtronic, Inc.Kink resistant cannula having buckle resistant apertures
US20050059963 *Sep 12, 2003Mar 17, 2005Scimed Life Systems, Inc.Systems and method for creating transmural lesions
US20050059964 *Sep 12, 2003Mar 17, 2005Fitz William R.Enhancing the effectiveness of medial branch nerve root RF neurotomy
US20050065509 *Sep 22, 2003Mar 24, 2005Scimed Life Systems, Inc.Flat electrode arrays for generating flat lesions
US20060025812 *Mar 31, 2005Feb 2, 2006Ethicon Endo-Surgery, Inc.Surgical instrument incorporating an electrically actuated pivoting articulation mechanism
US20070010801 *Jun 22, 2006Jan 11, 2007Anna ChenMedical device control system
US20070043261 *Aug 21, 2006Feb 22, 2007Olympus Medical Systems Corp.Endoscope and method for inserting endoscope into colon
US20080015413 *Feb 20, 2007Jan 17, 2008Olympus Medical Systems CorporationCapsule endoscope system and medical procedure
US20080021416 *Apr 6, 2007Jan 24, 2008Keio UniversityThin tube which can be hyperflexed by light
US20080022927 *Jul 28, 2006Jan 31, 2008Sean Xiao-An ZhangMicrofluidic device for controlled movement of material
US20090005636 *Oct 19, 2006Jan 1, 2009Mport Pte LtdDevice for Laparoscopic or Thoracoscopic Surgery
US20090015131 *Jul 10, 2007Jan 15, 2009Istvan WurschingCompact fluorescent lamp and method for manufacturing
US20090198212 *May 16, 2008Aug 6, 2009Tyler TimberlakeEndoscopic injection needle assembly inluding an endoscopic hood
US20100023032 *Jun 6, 2007Jan 28, 2010Luiz Gonzaga Granja FilhoProsthesis for anastomosis
US20100030211 *Jun 24, 2009Feb 4, 2010Rafael DavalosIrreversible electroporation to treat aberrant cell masses
US20100036198 *Feb 12, 2007Feb 11, 2010Roberto TacchinoDevice for the manipulation of body tissue
US20100049223 *Jun 6, 2007Feb 25, 2010Luiz Gonzaga Granja FilhoProsthesis for anastomosis
US20120004502 *Sep 13, 2011Jan 5, 2012Boston Scientific Scimed, Inc.Direct drive endoscopy systems and methods
US20120029335 *Jul 29, 2011Feb 2, 2012Cameron Health, Inc.Subcutaneous Leads and Methods of Implant and Explant
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US8037591Feb 2, 2009Oct 18, 2011Ethicon Endo-Surgery, Inc.Surgical scissors
US8070759May 30, 2008Dec 6, 2011Ethicon Endo-Surgery, Inc.Surgical fastening device
US8075572Apr 26, 2007Dec 13, 2011Ethicon Endo-Surgery, Inc.Surgical suturing apparatus
US8100922Apr 27, 2007Jan 24, 2012Ethicon Endo-Surgery, Inc.Curved needle suturing tool
US8114072May 30, 2008Feb 14, 2012Ethicon Endo-Surgery, Inc.Electrical ablation device
US8114119Sep 9, 2008Feb 14, 2012Ethicon Endo-Surgery, Inc.Surgical grasping device
US8157834Nov 25, 2008Apr 17, 2012Ethicon Endo-Surgery, Inc.Rotational coupling device for surgical instrument with flexible actuators
US8172772Dec 11, 2008May 8, 2012Ethicon Endo-Surgery, Inc.Specimen retrieval device
US8211125Aug 15, 2008Jul 3, 2012Ethicon Endo-Surgery, Inc.Sterile appliance delivery device for endoscopic procedures
US8226730 *Jun 17, 2010Jul 24, 2012Cook Medical Technologies LlcSurgical implant
US8241204Aug 29, 2008Aug 14, 2012Ethicon Endo-Surgery, Inc.Articulating end cap
US8252057Jan 30, 2009Aug 28, 2012Ethicon Endo-Surgery, Inc.Surgical access device
US8262563Jul 14, 2008Sep 11, 2012Ethicon Endo-Surgery, Inc.Endoscopic translumenal articulatable steerable overtube
US8262655Nov 21, 2007Sep 11, 2012Ethicon Endo-Surgery, Inc.Bipolar forceps
US8262680Mar 10, 2008Sep 11, 2012Ethicon Endo-Surgery, Inc.Anastomotic device
US8317806May 30, 2008Nov 27, 2012Ethicon Endo-Surgery, Inc.Endoscopic suturing tension controlling and indication devices
US8337394Oct 1, 2008Dec 25, 2012Ethicon Endo-Surgery, Inc.Overtube with expandable tip
US8353487Dec 17, 2009Jan 15, 2013Ethicon Endo-Surgery, Inc.User interface support devices for endoscopic surgical instruments
US8361112Jun 27, 2008Jan 29, 2013Ethicon Endo-Surgery, Inc.Surgical suture arrangement
US8403838Dec 12, 2007Mar 26, 2013Ethicon Endo-Surgery, Inc.Remote tissue retraction device
US8403839 *Dec 12, 2007Mar 26, 2013Ethicon Endo-Surgery, Inc.Remote tissue retraction device
US8403926Jun 5, 2008Mar 26, 2013Ethicon Endo-Surgery, Inc.Manually articulating devices
US8409200Sep 3, 2008Apr 2, 2013Ethicon Endo-Surgery, Inc.Surgical grasping device
US8425505Aug 25, 2011Apr 23, 2013Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US8449538Jan 27, 2010May 28, 2013Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US8454503Nov 17, 2005Jun 4, 2013Ethicon Endo-Surgery, Inc.Remote tissue retraction device
US8480657Oct 31, 2007Jul 9, 2013Ethicon Endo-Surgery, Inc.Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US8480689Sep 2, 2008Jul 9, 2013Ethicon Endo-Surgery, Inc.Suturing device
US8496574Dec 17, 2009Jul 30, 2013Ethicon Endo-Surgery, Inc.Selectively positionable camera for surgical guide tube assembly
US8506564Dec 18, 2009Aug 13, 2013Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US8529563Aug 25, 2008Sep 10, 2013Ethicon Endo-Surgery, Inc.Electrical ablation devices
US8568410Apr 25, 2008Oct 29, 2013Ethicon Endo-Surgery, Inc.Electrical ablation surgical instruments
US8579897Nov 21, 2007Nov 12, 2013Ethicon Endo-Surgery, Inc.Bipolar forceps
US8608652Nov 5, 2009Dec 17, 2013Ethicon Endo-Surgery, Inc.Vaginal entry surgical devices, kit, system, and method
US8652150May 30, 2008Feb 18, 2014Ethicon Endo-Surgery, Inc.Multifunction surgical device
US8679003May 30, 2008Mar 25, 2014Ethicon Endo-Surgery, Inc.Surgical device and endoscope including same
US8771260May 30, 2008Jul 8, 2014Ethicon Endo-Surgery, Inc.Actuating and articulating surgical device
US8784306Dec 12, 2007Jul 22, 2014Ethicon Endo-Surgery, Inc.Remote tissue retraction device
US8795166Dec 27, 2010Aug 5, 2014Ethicon Endo-Surgery, Inc.Remote tissue retraction device
US8828031Jan 12, 2009Sep 9, 2014Ethicon Endo-Surgery, Inc.Apparatus for forming an anastomosis
US8888792Jul 14, 2008Nov 18, 2014Ethicon Endo-Surgery, Inc.Tissue apposition clip application devices and methods
US8906035Jun 4, 2008Dec 9, 2014Ethicon Endo-Surgery, Inc.Endoscopic drop off bag
US8939902Dec 15, 2011Jan 27, 2015Ethicon Endo-Surgery, Inc.Remote tissue retraction device
US8986199Feb 17, 2012Mar 24, 2015Ethicon Endo-Surgery, Inc.Apparatus and methods for cleaning the lens of an endoscope
US9005198Jan 29, 2010Apr 14, 2015Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US9011431Sep 4, 2012Apr 21, 2015Ethicon Endo-Surgery, Inc.Electrical ablation devices
US9028483Dec 18, 2009May 12, 2015Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US9049987Mar 15, 2012Jun 9, 2015Ethicon Endo-Surgery, Inc.Hand held surgical device for manipulating an internal magnet assembly within a patient
US9220526Mar 20, 2012Dec 29, 2015Ethicon Endo-Surgery, Inc.Rotational coupling device for surgical instrument with flexible actuators
US9226772Jan 30, 2009Jan 5, 2016Ethicon Endo-Surgery, Inc.Surgical device
US9233241Jan 18, 2012Jan 12, 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US9254169Feb 28, 2011Feb 9, 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US9314620Feb 28, 2011Apr 19, 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US9375268May 9, 2013Jun 28, 2016Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US9427255May 14, 2012Aug 30, 2016Ethicon Endo-Surgery, Inc.Apparatus for introducing a steerable camera assembly into a patient
US9545290Jul 30, 2012Jan 17, 2017Ethicon Endo-Surgery, Inc.Needle probe guide
US20080091076 *Dec 12, 2007Apr 17, 2008Satiety, Inc.Remote tissue retraction device
US20100256778 *Jun 17, 2010Oct 7, 2010Wilson-Cook Medical Inc.Surgical Implant
Classifications
U.S. Classification600/129, 606/185
International ClassificationA61B17/34, A61B1/00
Cooperative ClassificationA61B1/2736, A61B1/12
European ClassificationA61B1/273D, A61B1/12
Legal Events
DateCodeEventDescription
Feb 21, 2011ASAssignment
Owner name: ETHICON ENDO-SURGERY, INC., OHIO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:NOBIS, RUDOLPH H.;REEL/FRAME:025839/0561
Effective date: 20080110